Laparoscopic treatment of gallbladder fistula: a retrospective clinical analysis of 24 cases / 中国医师进修杂志

ABSTRACT

Objective To explore the experience and efficacy of laparoscopic diagnosis and treatment of internal gallbladder fistula (IGF). Methods The clinical data of 24 cases of IGF treated by laparoscopic exploration/surgery were retrospectively analyzed in Shengjing Hospital of China Medical University from January 2012 to January 2018. Results All the 24 patients had underwent laparoscopic exploration and were confirmed as IGF. Among these patients, 16 cases had cholecystoduodenal fistula, 3 cases had cholecystocolic fistula, 3 cases had cholecystogastric fistula, and 2 cases had cholecystocholedo fistula (Mirizzi syndrome). All patients underwent cholecystectomy, and patients with common bile duct stones underwent common bile duct exploration and T tube drainage. Treatment of internal fistula includingduodenal fistula repair (16 cases), colon fistula repair (3 cases), gastric fistula repair (3 cases), duodenal fistula repair and gastrectomy (1 case), and Roux-en-Y cholangiojejunostomy (1 case). Eleven cases were performed laparoscopically (45.8％);13 cases were converted to open surgery (54.2％). Postoperatively, 2 patients experienced mild bile leakage and healed after active drainage for 2 months, and the rest recovered well. After 6 months of follow- up, no complications such as gastrointestinal fistula, obstruction, or stenosis occurred. Conclusions The clinical manifestations of gallbladder fistula generally lack specificity, so that preoperative diagnosis is difficult. IGF is hardly to self- heal, and surgical treatment is still the mainstay for treatment. For appropriate situation, experienced surgeons with the developed laparoscopic techniques are reliable treatment for IGF.